Older adults with type 2 diabetes have an increased risk of falls compared to those without diabetes, and this may contribute to their observed higher fracture rate. Although tight glycemic control reduces microvascular complications and may improve strength and balance, it may also increase falls due to hypoglycemic episodes. To address this issue, the ACCORD BONE ancillary study assessed the impact of intensive versus standard glycemic control on the rate of falls. ACCORD achieved a median A1C of 6.4% and 7.5% in the intensive and standard control group, respectively. ACCORD BONE included 54 of 77 ACCORD clinical sites (7,287 of 10,251 participants). At randomization, the average age of ACCORD BONE participants was 62.5 (SD 6.7) years. At annual follow-up visits, participants were asked about falls in the previous year. Average follow-up was 2.0 years. In the intensive group 1,122 of 3,364 participants and in the standard group 1,133 of 3,418 participants reported at least one fall during follow-up. The average rate of falls was 61.9 and 55.0 per 100 person-years in the intensive and standard control group, respectively. The frequency of falling between groups was compared using a random-effects negative binomial model for repeated measures. The rate ratio for falling was 1.10 (95% CI: 0.84, 1.43) for intensive versus standard glycemic control, adjusted for assignment to sub-trials and treatments in ACCORD and baseline CVD. Although more participants in the intensive group had a hypoglycemic episode requiring assistance (16.2% vs 5.1%) in ACCORD, this did not result in a higher rate of reported falls in the intensive group. Moreover, there was no evidence of interaction between intensive glycemic control and assignment to the ACCORD sub-trials (lipid and blood pressure) or treatments. In conclusion, intensive compared with standard glycemic control did not cause increased falls in older adults with type 2 diabetes.